TY - JOUR A1 - Heilig, Philipp A1 - Sandner, Phoebe A1 - Jordan, Martin Cornelius A1 - Jakubietz, Rafael Gregor A1 - Meffert, Rainer Heribert A1 - Gbureck, Uwe A1 - Hoelscher-Doht, Stefanie T1 - Experimental drillable magnesium phosphate cement is a promising alternative to conventional bone cements JF - Materials N2 - Clinically used mineral bone cements lack high strength values, absorbability and drillability. Therefore, magnesium phosphate cements have recently received increasing attention as they unify a high mechanical performance with presumed degradation in vivo. To obtain a drillable cement formulation, farringtonite (Mg\(_3\)(PO\(_4\))\(_2\)) and magnesium oxide (MgO) were modified with the setting retardant phytic acid (C\(_6\)H\(_{18}\)O\(_{24}\)P\(_6\)). In a pre-testing series, 13 different compositions of magnesium phosphate cements were analyzed concentrating on the clinical demands for application. Of these 13 composites, two cement formulations with different phytic acid content (22.5 wt% and 25 wt%) were identified to meet clinical demands. Both formulations were evaluated in terms of setting time, injectability, compressive strength, screw pullout tests and biomechanical tests in a clinically relevant fracture model. The cements were used as bone filler of a metaphyseal bone defect alone, and in combination with screws drilled through the cement. Both formulations achieved a setting time of 5 min 30 s and an injectability of 100%. Compressive strength was shown to be ~12–13 MPa and the overall displacement of the reduced fracture was <2 mm with and without screws. Maximum load until reduced fracture failure was ~2600 N for the cements only and ~3800 N for the combination with screws. Two new compositions of magnesium phosphate cements revealed high strength in clinically relevant biomechanical test set-ups and add clinically desired characteristics to its strength such as injectability and drillability. KW - magnesium phosphate cement KW - phytic acid KW - inositol hexaphosphate KW - drillable bone cement KW - tibial head depression fracture KW - synbones KW - artificial bones KW - biomechanical evaluation KW - cyclic testing KW - load to failure testing Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236633 SN - 1996-1944 VL - 14 IS - 8 ER - TY - JOUR A1 - Huflage, Henner A1 - Karsten, Sebastian A1 - Kunz, Andreas Steven A1 - Conrads, Nora A1 - Jakubietz, Rafael Gregor A1 - Jakubietz, Michael Georg A1 - Pennig, Lenhard A1 - Goertz, Lukas A1 - Bley, Thorsten Alexander A1 - Schmitt, Rainer A1 - Grunz, Jan-Peter T1 - Improved diagnostic accuracy for ulnar-sided TFCC lesions with radial reformation of 3D sequences in wrist MR arthrography JF - European Radiology N2 - Objectives Triangular fibrocartilage complex (TFCC) injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability. With its complex three-dimensional structure, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The aim of this study was to assess the added diagnostic value of radial reformatting of isotropic 3D MRI datasets compared to standard planes after direct arthrography of the wrist. Methods Ninety-three patients underwent wrist MRI after fluoroscopy-guided multi-compartment arthrography. Two radiologists collectively analyzed two datasets of each MR arthrogram for TFCC injuries, with one set containing standard reconstructions of a 3D thin-slice sequence in axial, coronal and sagittal orientation, while the other set comprised an additional radial plane view with the rotating center positioned at the ulnar styloid. Surgical reports (whenever available) or radiological reports combined with clinical follow-up served as a standard of reference. In addition, diagnostic confidence and assessability of the central disc and ulnar-sided insertions were subjectively evaluated. Results Injuries of the articular disc, styloid and foveal ulnar attachment were present in 20 (23.7%), 10 (10.8%) and 9 (9.7%) patients. Additional radial planes increased diagnostic accuracy for lesions of the styloid (0.83 vs. 0.90; p = 0.016) and foveal (0.86 vs. 0.94; p = 0.039) insertion, whereas no improvement was identified for alterations of the central cartilage disc. Readers' confidence (p < 0.001) and assessability of the ulnar-sided insertions (p < 0.001) were superior with ancillary radial reformatting. Conclusions Access to the radial plane view of isotropic 3D sequences in MR arthrography improves diagnostic accuracy and confidence for ulnar-sided TFCC lesions. KW - joint instability KW - wrist KW - arthrography KW - magnetic resonance imaging KW - triangular fibrocartilage Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266512 SN - 1432-1084 VL - 31 IS - 12 ER - TY - JOUR A1 - Jakubietz, Michael Georg A1 - Jakubietz, Danni Felicitas A1 - Schmidt, Karsten A1 - Jakubietz, Rafael Gregor T1 - Blepharoplastik bei asiatischen Augen JF - Journal für Ästhetische Chirurgie N2 - Die operative Verjüngung des Auges stellt einen der am häufigsten nachgefragten Eingriffe im ästhetischen Spektrum dar. Die multikulturelle Bevölkerungsstruktur bedingt, dass auch „asiatisch“ imponierende Augen behandelt werden. „Asiatische“ Augen sind aber nicht nur bei Asiaten anzutreffen, sondern in unterschiedlicher Ausprägung auch bei Patienten aus dem Nahen und Mittleren Osten. Das asiatische Auge stellt in Bezug auf Verjüngungsmöglichkeiten eine eigene Entität dar. Während die klassische „Korrektur“ des asiatischen Auges eine etablierte und durch eine Vielzahl von verschiedenen Techniken mit vorhersehbaren Ergebnissen verbundene Methode ist, ist eine „verjüngende“ Blepharoplastik des asiatischen Auges komplexer zu bewerten [1, 3, 5, 10]. Die Operationsmethoden für das „asiatische“ Auge sind für jüngere Patienten intendiert, bei denen es überwiegend um die Korrektur des Epikanthus geht. Diese Techniken ziehen eine gewünschte Veränderung des periorbitalen Erscheinungsbildes nach sich, wobei das asiatische Aussehen teilweise zugunsten eines vermehrt „europäischen“ Aussehens beeinflusst wird. Fraglich bleibt, ob eine Veränderung zu einem europäischen Aussehen hin auch bei einem alternden Patienten einer Verjüngung gleichkommt. Prinzipiell imponiert ein derart operiertes asiatisches Auge „künstlich“, eine Tatsache die bei alternden Patienten als noch störender als der Alterungsprozess selbst empfunden werden dürfte. Daher ist der Wunsch nach einer Verjüngung ohne Verlust des typischen asiatischen Erscheinungsbildes des Auges chirurgisch nicht mit der klassischen Technik bei Europäern umzusetzen. Während die Behandlung durch eine klassische Blepharoplastik ein unnatürliches Aussehen zur Folge hat, kann unter Respektierung der asiatischen anatomischen Besonderheiten eine natürlich wirkende Verjüngung erreicht werden. KW - Blepharoplastik KW - asiatische Augen KW - operative Verjüngung Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-270189 SN - 1867-4313 VL - 14 IS - 4 ER - TY - JOUR A1 - Schmidt, Karsten A1 - Jakubietz, Michael Georg A1 - Gilbert, Fabian A1 - Fenwick, Annabel A1 - Meffert, Reiner Heribert A1 - Jakubietz, Rafael Gregor T1 - Muscle cuff in distal pedicled adipofascial sural artery flaps: a retrospective case control study JF - PRS Global Open N2 - Background: Amputation after open tibial fracture occurs in 3% of cases. The rate increases when flap reconstruction is required. The standard care involves microsurgical tissue transfer although the pedicled reverse sural artery adipofascial flap (PRSAF) is a local alternative in patients endangered by a prolonged operative time. Incorporation of a gastrocnemius muscle cuff in this flap can be used to fill dead space and increase healing potential. Literature shows superior survival rates for both PRSAF and inclusion of a muscle cuff in comparison with the cutaneous version. The aim of the study was to compare the outcome of the PRSAF and the musculoadipofascial version (PRSMAF). We hypothesize that the PRSMAF provides similar lap viability and flap-related complication rates as does the adipofascial version. The muscle component may reduce the long-term osteomyelitis rate. Methods: Patients were evaluated retrospectively after reconstruction with either PRSAF or PRSMAF. Preoperative osteomyelitis, flap survival, complications and osteomyelitis clearance were analyzed. Results: The study shows preliminary results supporting the potential use of the PRSMAF. We compare either 23 PRSMAF or 20 PRSAF flaps. We found no statistically significant differences in flap survival or in complication rate. Conclusions: Although the anatomical situation may sometimes dictate the use of a free flap, a technically less-complicated option may in some cases offer a viable alternative. This study shows that the PRSMAF can serve as an alternative for complex bone defects in the limb, though it does not provide statistical improvement to the PRSAF. KW - muscle cuff Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259875 VL - 9 IS - 3 ER - TY - JOUR A1 - Schmidt, Karsten A1 - Jakubietz, Michael Gregor A1 - Gilbert, Fabian A1 - Hausknecht, Franca A1 - Meffert, Rainer Heribert A1 - Jakubietz, Rafael Gregor T1 - Quality of life after flap reconstruction of the distal lower extremity: is there a difference between a pedicled suralis flap and a free anterior lateral thigh flap? JF - Plastic and Reconstructive Surgery - Global Open N2 - Background: Flap reconstruction of the distal lower extremity is challenging. Especially, the concept of perforator surgery has increased available surgical options. Although results are generally judged in terms of objective facts, patients-perceived quality of life has largely remained unexamined. The aim of the study was to compare quality of life after lower extremity reconstruction with pedicled and free flaps. Methods: Patients were evaluated retrospectively after reconstruction of defects of the distal lower extremity either with distally based adipofascial sural flap (pedicled reverse sural flap) or an anterior lateral thigh (ALT) flap. A specific questionnaire was developed to measure the patient’s quality of life, based on short form health survey-12, Dresden Body Image Score-35, Patient Health Questionnaire-4, and XSMFA questionnaires with additional specific questions. Furthermore, results, secondary surgeries, and complications were analyzed. Results: Thirty-seven patients with reconstruction of lower limb defects treated with a pedicled reverse sural flap and 34 patients treated with an ALT flap were included in the study. There was no statistical significant difference in the overall satisfaction with the procedure in the long-term follow-up between both groups, but patients with ALT showed a higher satisfaction with the treatment in the initial postoperative period. Both groups demonstrated approximately similar results in the long term for self-acceptance and vitality. Conclusions: Although anatomic situation may dictate flap choice coverage with free flaps, a less-complicated flap is by no means regarded as an inferior treatment option in patient’s estimation. Despite the intuitive speculation that patients with more advanced reconstruction methods should have better function and subsequently higher quality of life, this assumption was clearly not supported by data in this study. KW - reconstructive surgery Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203940 VL - 7 IS - 4 ER -